My endodontic journey

This past spring, I attended the annual AAE meeting in Boston, Massachusetts. It was packed with new innovation, technology, and doctors. Key lecturers spoke on using various technologies for optimum results. Some advocated if you don’t use this particular solution, device, or technique, then you are doing it wrong. This made me do some serious self-reflection.

I thought about my second year at The Medical College of Georgia School of Dentistry in 1996. We learned the basics on extracted teeth before working on a real live patient. We had only hand files, bleach (household), and gutta percha after accessing the tooth.

Balanced force and step-back procedures were all done by hand instrumentation. It took a long time to perform the cleaning and shaping procedure, and most cases were done in 2 or 3 visits. Once the case was cleaned and shaped, irrigated with bleach, and canals dried, it was time for filling the canal. The sealer was mixed and was placed inside the canal. The gutta-percha cone was seated. An alcohol torch or bunson burner was used for the warm vertical condensation technique. A sharp metal instrument was heated to a cherry-red color, and then carefully placed inside the canal to heat up the gutta percha (all the while, we prayed not to burn the patient’s lip). Most procedures took over 2 hours. Despite this “ancient” technology, root canals still were very successful. In fact, success rates have not changed dramatically in the past 50 years despite the new technologies.

What’s the point?  Technology changes but teeth don’t.

When you think of the best root canals, do you envision sleek dental offices and the most modern technology? Most of us do, but the practice of treating infected teeth has roots (literally) that stretch back over 2,000 years. The core idea — to relieve pain and save the natural tooth — remains the same.

Root canal therapy has advanced significantly, thanks to innovations like: 

• X-rays(discovered in 1895), for accurate imaging of internal tooth structure.
• Local anesthetics, which made procedures more comfortable and accessible.
• Digital radiography and 3D cone-beam imaging for detailed diagnosis.
• Rotary endodontic systemsand ultrasonics for faster, cleaner procedures.
• Heat-treated endodontic files, which allow files to be pre-curved to reach smaller areas and around severely curved canals.
• Dental operating microscopes that offer unparalleled visibility.
• Bioceramic sealers that improve sealing and biocompatibility.

These advancements have helped endodontics to become more precise and efficient. However, the success rates have not changed significantly over the past 50 years. If endodontics is performed according to the basic biological principles, a successful outcome of 90% or more is still the standard.

Root canal therapy has a fascinating history, evolving from early attempts with bronze tools to today’s precise, comfortable procedures. Despite the fears and myths, endodontics remains one of the most important ways to save natural teeth — and its long history proves it still works.